Chapter 31: Health Supervision Flashcards
Medical home
The primary physician who has a long-term and comprehensive relationship with the family. Characteristics include care accessible and in the child’s community. All insurance including Medicaid excepted. Family centered care provided. Able to speak to the doctor when needed. Partnership based on trust and respect. Preventative care provided. Ambulatory and inpatient care available 24 hours a day. Care from infancy through adolescence. Coordinated care with other physicians. Availability of referrals for subspecialties. They work to meet the nonmedical and medical needs of the child. Relationships with the school and community. Centralized database. Concern for the well-being of the child and family. Respect for the culture and religious beliefs.
Help supervision for that chronically ill child
It includes frequent psychosocial assessments which include health insurance coverage, transportation to healthcare facilities, financial stressors, family coping, and the schools response. Nurses may need to assist families and schools in learning and being able to help the child
Health supervision of the child adopted internationally
Includes a comprehensive screening for infectious disease. China, Ethiopia, and Russia supplies half of the adoptees. South Korea and the Ukraine come in next. This is important to the child’s health and the community. Should be done with in a few weeks of arrival to the US.
Intestinal parasites called Giardia lamblia the most common pathogens and may be symptom-free. Latent TB is common. Hepatitis B, HIV, and syphilis infection screening is recommended.
Components of health supervision
Visits are recommended at birth, one week, one, two, four, six, nine, 12, 15, 18, 24, 30 months and then yearly until 21. Includes a physical health along with intellectual and social development, and parent-child interaction.
History and physical, including head circumference until two years, height, and weight.
Developmental/behavioral assessment.
Sensory screening of vision and hearing.
Appropriate at risk screening such as lead, anemia, TB, hypertension, cholesterol.
Immunizations
Health promotion and anticipatory guidance such as injury prevention, violence prevention, and nutritional counseling.
Developmental surveillance and screening
Includes noting and addressing parental concerns.
Obtaining a developmental history.
Making accurate observation.
Consulting with relevant professionals.
Risk factors for developmental problems
Birthweight less then 1500 g.
Gestational age less than 33 weeks.
Central nervous system abnormality.
Hypoxic ischemic encephalopathy.
Maternal prenatal alcohol or drug abuse.
Hypertonia/ypotonia
Hyperbilirubinemia requiring exchange transfusion.
Kernicterus
Congenital malformations.
Symmetric intrauterine growth deficiency.
Perinatal or congenital infection.
Suspect sensory impairment.
Chronic otitis media with effusion lasting more than three months. Inborn error of metabolism.
HIV.
Lead level above 19 mg.
Inappropriate parenting.
Parents with less than high school education.
Single-parent.
Sibling with developmental problems.
Parents with developmental or mental illness
Losing a developmental milestone
Needs an immediate full evaluation and may indicate a significant neurologic problem
Developmental screening tools
The Denver two is used for diagnostic purposes only when administered by specifically trained personnel. If not trained they should use tools based on the Denver two. The tools assist nurses in identifying infants and children and they develop developmental delays, allowing for prompt identification and referral for evaluation. Additional data such as handwriting, ability to draw, school performance, and social skills may be evaluated
Risk assessment
Is performed by the physician in conjunction with the child and includes objective and subjective data to determine the likelihood that the child will develop a condition. Selective screening is done when a risk assessment indicates the child has one or more risk factors for a disorder.
Metabolic screening
Is determined by state law. The March of Dimes recommends universal newborn metabolic screening test for 29 disorders. Include amino acid disorders, organic acids disorders, fatty acid oxidation disorders hemoglobinopathies, and others.
During the initial visit, the nurse must make sure the metabolic screening was performed prior to discharge. If it was not performed or if it was performed before 24 to 48 hours, it should be repeated at the initial visit.
Hearing screening
Hearing screening should be done before discharge from the hospital. If not it needs to be done before one month of age. Behavioral observations are not sensitive enough to determine hearing loss.
The Weber and Rinne test for sensorineural or conductive hearning loss. Universal screening with objective testing is recommended that ages 4568 and 10. On the other years it should be a risk assessment followed by testing if needed
From age 3 months to four years includes auditory skill monitoring, developmental surveillance, assessment of parental concerns. After 4 years assess risk for difficulty hearing on the telephone, difficulty hearing in a noisy background, frequent asking of others to repeat themselves, turning the television out loud
Vision screening
Performed at every scheduled help supervision visit. The newborn should fixate on an object 10 to 12 inches. They should be able to follow the object to midline. At 2 months old they should be able to follow the object 180°. Use objects with black-and-white patterns on infants younger than six months. At three years you may use the tumbling E and the Allen figures chart. After five or six years when they know the alphabets use the standard Snellen chart. Place the chart at eye level. Make sure it is well lit. Mark the appropriate distance. Have the child read each line with one eye covered and then the other eye. They can leave the other eyes open as long as it is covered. Then have the child sleep with both eyes open. Also screen for color discrimination (Ishihara charts)
Risk for hearing impairment
Family history of hearing loss
prenatal infection
anomalies at the head face or ears
Low birth weight under 1500 g.
Hyperbilirubinemia requiring the exchange transfusion.
Ototoxic medications.
Low Apgar scores under four at one minute or under six at five minutes.
Mechanical ventilation lasting five days.
Syndrome associated with hearing loss.
Head trauma.
Bacterial meningitis.
Neurodegenerative disorders
Persistent pulmonary hypertension.
Otitis media with effusion for three months.
Iron deficiency anemia screening
Screen all full-term infants at 9 to 12 months. Selectively screen at four months, at 18 months, annually after 2 if at risk
At 6-10 if vegetarian
11-21 females every 5-10 years throughout childbearing years.
Risk factors include rapid growth, low birth weight, preterm, vegetarian, inappropriate consumption of cows milk, infant formula lacking in iron, breast-feeding after four months without supplementation, frequent dieting, exposure to lead, Feeding problems, pregnancy or recent pregnancy, intense physical training, blood loss, heavy periods, chronic aspirin or NSAID medication, parasitic infections, low income families, WIC families
Hypertension screening
Recommended to start at three years old. Determining hypertension in children and adolescents utilizes body size in order to be precise. Risk factors include preterm birth, low birth weight, renal disease, organ transplant, congenital heart disease, or other illnesses.
